Why Bay Staters Voted The Way They Did On The Ballot Questions — And What It Means

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Despite the tens of millions of dollars spent on the ballot question campaigns, and despite pro and con ads blanketing the airwaves, none of the vote tallies were even close. All three ballot questions had spreads in the double digits and stayed true to the latest pre-election polling.

Here’s a look at why the vote for each question went the way it did, and what it means.

Question 1: Nurse-Patient Ratios

Voters resoundingly rejected a proposal by a nurses’ union to establish strict limits on the number of patients that could be assigned to a nurse in hospitals across Massachusetts.

Early polling suggested voters sided with the nurses’ union that backed the measure — the Massachusetts Nurses Association (MNA). But as election day neared, polling flipped. The polls just before election day indicated voters wanted to keep the current system in place, which gives hospitals discretion in establishing nurse staffing levels.

Three factors likely contributed to this outcome.

First and foremost, an independent state agency tasked with implementing the staffing ratios — the Health Policy Commission — did its own analysis. The agency calculated that the proposed measure would cost between $676 million and $949 million a year, if not more.

This appeared to be a big deterrent for voters, as the independent analysis warned this price tag might lead hospitals to close unprofitable units and could translate to higher insurance premiums.

Second, the nurses’ union pushing the measure made patient safety the centerpiece of its campaign. The union argued that nurses are overworked, and that puts patients at risk. However, data from California, the one state to has strict legal nurse-patient ratios, suggests that strict ratios do not necessarily lead to better patient outcomes. On some measures, things got better, and on other measures, things got worse.

In California, ratios did appear to benefit nurses, who won higher pay and experienced less burnout and lower injury rates. However, this was not how the MNA framed its push for Ballot Question 1.

Third, the ‘No on 1’ campaign — largely funded by hospitals — vastly outspent the nurses’ union. Much of that money went to dramatic TV ads that warned of dire consequences and limited access to timely healthcare. These ads sowed questions and concerns among voters and seem to have been enough for some voters to want to keep the status quo.

What does this outcome mean? It means nothing changes.

The MNA has been lobbying for legal nurse-patient ratios for two decades. Since the union's efforts didn’t succeed on Beacon Hill, nor in conference rooms with hospital executives, they brought the issue to voters, hoping to be able to convince them. While that didn’t happen, and the final tally was not even close, the ‘Yes on 1’ campaign says the fight was worth it.

“The most important thing is that people know now what a standard of care needs to be in the hospital,” said Donna Kelly-Williams, president of the MNA, on election night. “And they know to ask the question, if they or their loved ones are in the hospital, 'How many patients are you taking care of tonight?'”

While Massachusetts citizens may now be more informed about the issue and could put pressure on lawmakers, hospital executives may be less likely to compromise or consider staffing limits because their side won this ballot question so handily.

But Kelly-Williams vowed to keep fighting. She acknowledged being “very disappointed” by the results; however, she said the nurses’ union would regroup and continue its decades-long push for nurse staffing limits.

In the lead-up to the election, Ballot Question 2 received the least amount of attention and money — by far.

Proponents of the measure billed it as a way to start overturning Citizens United, the contentious 2010 Supreme Court decision that has come to symbolize unchecked corporate spending aimed at influencing politics. That seemed to convince voters.

What the measure actually does is create a commission of 15 unpaid citizens to study the issue of money in politics at a state and federal level. The commission will then write a report on what it finds. The vote tallies suggest that Massachusetts voters saw Ballot Question 2 as an opportunity to make a statement and take a stand against outside money in politics — although it is unclear what impact the commission will have.

The decisive victory for the ‘Yes on 2’ campaign was not surprising, given that across the state and country, voters overwhelmingly support limiting corporate spending in politics. It also helped that there was no organized opposition to the measure.

Question 3: Maintaining Transgender Protections in Public Places

Ballot Question 3 was the first statewide referendum on transgender rights in the country.

Both sides acknowledged potential national implications: If transgender rights were struck down in a very blue state, they can be struck down elsewhere in the country. However, by a wide margin, voters decided to keep a 2016 law on the books that protects transgender people from discrimination in places open to the public.

The two sides of Ballot Question 3 ran very different campaigns. The ‘No on 3’ campaign to repeal the non-discrimination protections focused its money and energy on running ads. The ads highlighted fears about women and children's safety and privacy. They suggested men might pretend to be transgender in order to enter women’s bathrooms and locker rooms and prey on girls.

The ‘Yes on 3’ campaign — to keep the 2016 law protecting transgender people — countered those ads with its own ads, pointing out that there was no data to back up these fears. But the ‘Yes on 3’ campaign didn’t just rely on ads; unlike the ‘No on 3’ campaign, they had a big ground operation. They organized canvassing efforts across the state and held lots of local events. Their message focused on protecting everyone’s rights and dignity. It is that message that appears to have won Massachusetts voters over.

Technically, the strong 'Yes' vote for Question 3 means nothing changes, and the 2016 law protecting transgender individuals stays on the books. However, members of the transgender community say this victory means they feel more secure and welcome in Massachusetts.

On election night, Kasey Suffredini, co-chair of the 'Yes on 3' campaign, said he was relieved.

“I'm going to leave this hotel which I'm legally protected to be in, and I'm going to walk down the street, and I'm going to know that every two of three people I see believes that I am deserving of dignity and respect," he said. "I'm so grateful to the Commonwealth.”

Members of the ‘Yes on 3’ campaign emphasized the importance of this victory, given the Trump administration’s efforts to repeal transgender protections.